PHASA Conference 2015: Opening Ceremony

Hosts Welcome Delegates to eThekwini Municipality

Counsellor Simon Zwane welcomed the 2015 PHASA conference delegates to eThekwini municipality and the Moses Mahbida Stadium. He shared with them the municipality’s vision – for all citizens to have houses, food and jobs.

Counsellor Zwane asserted that the PHASA conference theme of Health and Sustainable Development: the future, occurs at a time when “the Millennium Development Goals (MDG’s) make us realise that we’re far from reaching them, and patient expectations are increasing as health systems and facilities are struggling to cope.”

The councillor reiterated the significance of research, training, service delivery, and synergy for the health system, and highlighted the need for a mechanism to strengthen the public health system.

PHASA President, Dr Julia Moorman, welcomed delegates to the conference and spoke about the importance of sustainable development for health and the importance of health for sustainable development.

Of priority for PHASA is that goal three of the 17 SDG’s is “health and wellbeing for all ages”. This challenges the public health community to action. “Although, under that goal there are nine targets and four ‘means of implementation,’ concerns have been raised that health, unlike in the MDG’s, hasn’t taken centre stage,” says Moorman.

Moorman stated that there were concerns that health’s lower profile will mean less national commitment and called for the development of an agenda that “puts the physical and mental wellbeing of all South Africans at its heart”.

“We need to strive to strike a balance between being visionary and practical and we need to identify what we should do in the short to medium term to make an immediate and positive impact on people’s health and identify what we should do in the future about longer term challenges that require a more sustained approach,” says Moorman in her speech.

Panel Discussion: challenges and successes in service delivery, training and public health research

Dr Elizabeth Lutge, from the KwaZulu-Natal Department of Health was the panel Chair. The panel speakers were all public health specialists from KZN in the research, training and service delivery field.

Research

Dr Kogieleum Naidoo from the Centre for the Aids Programme of Research in South Africa (CAPRISA), contextualised Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) in the province – “45% of HIV infected adults in South Africa know their status, 39% are accessing Anti-Retroviral Treatment (ART), and 29% are retained in care and are virologically suppressed with good adherence to ART.”

“The 71% of HIV infected people that aren’t virally suppressed has enormous implications for both HIV prevention and treatment efforts” says Naidoo.

She also highlighted the challenge of TB in the province “KwaZulu-Natal is the epicentre of TB HIV co-infection,” says Naidoo. The statistics have shown that 1.2 million HIV-infected individuals have a TB co-infection rate of 70% and a background TB notification rate of 1,094 cases per population of 100,000.

Although just under 1 million patients are currently accessing ART, only about 40% receive monthly viral load tests, among whom, about 80% are suppressed.

Other challenges facing the province as the high co-burden of non-communicable disease such as hypertension and diabetes.

Naidoo spoke about the value contribution research can make to health service delivery. Research can show what works,” says Naidoo, “but to have an impact it needs to be implemented on a large scale.”

Health system successes such as Prevention of Mother-to-Child Transmission (PMTCT) are an example of how research demonstrated an approach on how to reduce transmission and wide scale implementation has resulted in a dramatic decrease in MTCT.

Research has shown that ART is reducing mortality and keeping people alive longer, and a number of strategies has been proven to prevent sexual transmission of HIV. Moreover, evidence of the impact of these strategies on the epidemic trajectory at community level has been accumulating steadily.

Naidoo states that there’s a need to optimise evidence across the cascade of care, and to provide an interface for researchers and trainers, however, “sometimes you need to be in your silo to do your research before you can share it with trainers or service delivery professionals,” says Naidoo.

Training

Dr Bernhard Gaede, Head of Department of Family Medicine at the University of KwaZulu- Natal (UKZN) used the Memorandum of Understanding (MOU) between the UKZN and the Department of Health (DOH) as a point of departure to discuss the planning of a decentralised training platform in KwaZulu-Natal.

The plan addresses increasing the number of trained public health professionals and shifting the geographic distribution and location of training. “These developments would necessitate changes in the curriculum for health professional education,” says Gaede.

Gaede reflected on the underlying need to look at new and innovative ways of training and developing curricula and to develop a critical pedagogy of social justice.

Encouraging PHASA delegates to engage with this, Dr Gaede implored public health professionals to engage in asking questions regarding what kind of health care professional we need for the future of South Africa. We need to look for the answers to some critical questions:

  1. What does a socially just curriculum look like?
  2. Is a shift in location from the current system to decentralisation enough?
  3. How much primary health care exposure is enough for training health professionals?
  4. What is transformational change? How do you build agency?

Gaede claimed that the othering (tendency to turn people into patients) needs to be addressed if we are seeking to produce a different kind of health care professional. The curriculum shift needs to develop a stronger population perspective by increasing the Primary Health Care (PHC) link to Community Orientated Primary Health Care (COPC) and the re-engineering of PHC.

The problem is deep suggests Gaede while pointing out the disconnect between the life-worlds of patients and communities with that of the health care system, research and the curriculum. “The curriculum needs to be designed to be engaged in, and connected to the local context,” says Gaede.

Service delivery

Tryphinah Ngwenya from the Office of the Premier is a Senior Manager in the Department of Health. She discussed the successes, challenges and lessons learned from Operation Sukuma Sakhe (OSS)- an integrated service delivery model, that uses the War Room (WR) concept in eThekwini.

Ngwenya stresses the value of the WR structure and the fact that community dialogues, participation and feedback are critical strategies to keep communities at the centre of development.

In the WR’s, Community Care Givers (CCG’s) and civil society organisations employed by Non Profit Organisations (NPO’s) for service delivery should be active participants engaging with representatives from all tiers of government. “The CCG’s are the mainstay of the War Rooms,” says Ngwenya.

Proving crucial to the success of the WR’s is high level leadership, ownership and buy-in and support at all levels (local, district and provincial) on a political, administrative, and community level. “Functional War Rooms require multi stakeholder participation,” says Ngwenya.

The integration of multi-sectoral stakeholder functions and roles of CCG’s from the DoH and the Community Development Workers, and from the Department of Social Development avoids redundancy helping to create synergy. “Integration is complex and challenging; all fieldworkers and stakeholders need to use the War Room to provide seamless and coordinated service delivery,” says Ngwenya.

The OSS model aligns itself with existing institutional structures, and community members are WR convenors which proved critical in co-creating ownership. Based on the success of the OSS practical experience, Ngwenya says, “We should institutionalise War Rooms.”

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